Ear infections (a.k.a. otitis media) are the most common childhood conditions for which antibiotics are prescribed, even though many cases are actually caused by the same upper respiratory viruses that result in the common cold. Each year in the United States, the AAP estimates that there are more than 5 million acute ear infections (AOM) diagnosed, more than 10 million antibiotic prescriptions written to treat them, and about 30 million encounters with pediatricians and other healthcare professionals for care. That’s a lot of time and money spent at the doctor’s office and pharmacy, not to mention the sleepless nights comforting a child suffering with ear pain.

Once upon a time, bacterial ear infections (a.k.a. otitis media) were most commonly caused by Pneumococcus pneumoniae (and less commonly by Haemophilus influenzae, and Moraxella catarrhalis — more on those two later). Fortunately, most cases of S. pneumoniae ear infections respond to a simple and inexpensive antibiotic — amoxicillin (a.k.a. “The Pink Stuff”). Unfortunately, S. Pneumonia can cause serious, invasive, and not-that-uncommon complications and diseases — situations in which simple amoxicillin won’t do. In addition to causing bacterial pneumonia, which can be a serious and life-threatening infection at any age, but especially at both ends of the age spectrum, bacterial meningitis is (or was, as we shall soon see) the most feared disease caused by S. pneumoniae, especially in the pediatric population. Unless this not-so-rare infection is identified and treated with heavy doses of intravenous antibiotics almost as soon as symptoms commence, poor outcomes are typical, with high mortality rates and severe, usually permanent neurologic damage in survivors.

The fear in every parent’s mind when an infant or young child has a high fever has always been these types of horrible bacterial infections caused by S. pneumoniae. However, since 2000, there has been a vaccine available to prevent both mild and catastrophic infections caused by S. pneumonia in children and allay parental “fever phobia.” (In 2010, Prevnar 13 displaced the original Prevnar 7 as the vaccine of choice by providing coverage for 6 additional bacterial strains. Prevnar 13 is now given to infants at 2, 4, and 6 months of age, with a booster dose at 12-15 months.)

How successful has the pneumococcal conjugate vaccine been in preventing disease? Very. A recent study in Pediatrics found a sharp decline in ear infections caused by S. pneumonia since the vaccine was introduced. Even though kids still get ear infections (factors include attendance in germ-prone child care and exposure to secondhand smoke), S. pneumonia is no longer the primary bacterial cause. Those two other trickier-to-treat bacteria mentioned before have taken its place:

On the other hand, the pneumococcal vaccine has been so effective at reducing ear infections caused by Streptococcus pneumoniae that other bacteria have stepped up to become the main source of current ear infections, the study authors said.

These bacteria include Haemophilus influenzae and Moraxella catarrhalis, Pichichero said.

These bacteria are not killed by amoxicillin, the top-recommended antibiotic for ear infections, he said. After learning this during his study, Pichichero and his team prescribed amoxicillin clavulanate (brand name Augmentin) instead, or an antibiotic called cefdinir if the child was allergic to the former.


Another study highlights the success of the pneumococcal vaccine: Rates of invasive S. pneumonia infections like bacterial meningitis have sharply declined since the vaccine was introduced, says Michael Smith:

The 6 years after the 13-valent pneumococcal vaccine (Prevnar 13) was introduced saw a sustained drop in the rate in invasive pneumococcal disease (IPD) among children and adults, researchers reported here…

Vaccine expert Kathryn Edwards, MD, of Vanderbilt University School of Medicine in Nashville, who moderated the IDWeek session, lauded the “beautiful data” in the study. “It’s a continuing story,” she told MedPage Today, and the surveillance data “allows us to see” how well the vaccine is working.

For a pediatrician, “It’s wonderful to rarely see meningitis and the burden of bacterial pneumonia is much less” since the pneumococcal vaccines have been used, she noted.


I’ll say. I think I can speak for every pediatrician and say I hope to never see another case of Streptococcal pneumonia meningitis again. Make sure to immunize your infants and children completely and on time.


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